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López Soto Á, Velasco Martínez M, Ferrández Martínez M, Díaz García A, García Izquierdo O, Marín Sánchez P. Prenatal ambiguous/atypical genitalia: why are we still missing it and how can we improve diagnosis? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:581-585. [PMID: 37773980 DOI: 10.1002/uog.27507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Á López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - M Velasco Martínez
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - M Ferrández Martínez
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - A Díaz García
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - O García Izquierdo
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
| | - P Marín Sánchez
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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Rickard M, Kim JK, Van Mieghem T, Shinar S, McKay A, Santos JD, Brownrigg N, Keefe DT, Lorenzo AJ, Chua M. The Toronto nomogram: A Bayesian meta-regression derived prenatal ultrasound index to predict lower urinary tract obstruction and prune belly syndrome. Prenat Diagn 2024; 44:117-123. [PMID: 37165481 DOI: 10.1002/pd.6384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/29/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION A nomogram for predicting the diagnosis of lower urinary tract obstruction (LUTO) based on an antenatal ultrasound index generated from a Bayesian Meta-regression analysis has been in development and noted with superior diagnostic accuracy compared to the keyhole sign (KHS). We aim to assess the accuracy of the nomogram in expanded diagnostic utilization to predict LUTO. METHODOLOGY The validation of the nomogram for expanded diagnostic utilization was based on data from a prospective institutional antenatal clinic database between January 2020 and June 2022. Diagnostic accuracy indices were determined for confirmed postnatal diagnosis of LUTO or prune belly syndrome (PBS). Receiver operating characteristics (ROC) curves were generated to compare the area under the curve (AUC) of the nomogram versus KHS. RESULTS Based on 84 male fetuses with antenatal ultrasound of moderate-severe hydronephrosis (PUV n = 15, PBS n = 4), the KHS had 26.3% (95%CI 9.1-51.2) sensitivity and 100% (95%CI 94.4%-100%) specificity, with 14 false-negatives. The nomogram showed a 84.2 (95%CI 60.4%-96.6%) sensitivity and 95.4 (95%CI 87.1%-99%) specificity with three false-positives. The nomogram also had a superior AUC compared to KHS (0.98 vs. 0.63). CONCLUSION The nomogram can be used as a valuable tool to trigger further postnatal screening and provide individualized risk assessments to families during prenatal counseling.
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Affiliation(s)
- Mandy Rickard
- Divison of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jin Kyu Kim
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Ashlene McKay
- Division of Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joana Dos Santos
- Divison of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Natasha Brownrigg
- Divison of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Daniel T Keefe
- Division of Pediatric Urology, Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Armando J Lorenzo
- Divison of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Michael Chua
- Divison of Urology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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López Soto Á, Bueno González M, Urbano Reyes M, Carlos Moya Jiménez L, Beltrán Sánchez A, Garví Morcillo J, Velasco Martínez M, Luis Meseguer González J, Martínez Rivero I, García Izquierdo O. Imaging in fetal genital anomalies. Eur J Obstet Gynecol Reprod Biol 2023; 283:13-24. [PMID: 36750003 DOI: 10.1016/j.ejogrb.2023.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Genital anomalies are a heterogeneous group of congenital pathologies that have become increasingly relevant since the Chicago Consensus of 2005. Their postnatal diagnosis has developed significantly in the last two decades, while prenatal diagnosis seems to be underdeveloped, with few protocols available, fragmented scientific literature, and low diagnostic rates. This review aims to examine the current status of this subspecialty from the perspective of prenatal imaging. Indications for the evaluation of fetal genitalia can be divided into medical and non-medical reasons. Medical reasons include sex-linked disorders, detection of other anomalies, relevant family history, or multiple pregnancy. Non-medical reasons include parental request for sex disclosure. Disclosure of fetal sex may be associated with ethical, legal, and medical issues. The main imaging technology used is 2D ultrasound, although there are other complementary techniques such as 3D, MRI, or Color Doppler. Regarding working methodology, several authors have drawn attention to the lack of standardized protocols and guidelines. Most guidelines tend to limit their recommendations to study indications and ethical issues. Technical proposals, measurements, or working methods have not yet been standardized. Fetal sex determination is usually divided into early and late gestation. Early gestation is based on the sagittal sign. Late gestation is based on direct visualization. There are several measurements to describe male and female genitalia, such as penile length, bilabial diameter, or scrotal diameter. Prenatal diagnosis of genital pathologies presents some particularities such as the wide spectrum of phenotypes, the high frequency of associated deformities, or the time of diagnosis. Some of the most frequent pathologies are ambiguous genitalia, fetal sex discordance, hypospadias, micropenis, clitoromegaly, ovarian cysts, hydro(metro)colpos, and cloacal anomalies. Higher-quality studies and direction from scientific societies through the implementation of clinical guidelines are needed.
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Affiliation(s)
- Álvaro López Soto
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain.
| | | | - Maribel Urbano Reyes
- Prenatal Diagnosis Unit, Department of Obstetrics, HGU Santa Lucía, Cartagena, Spain
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Keefe DT, Kim JK, Mackay E, Chua M, Van Mieghem T, Yadav P, Lolas M, Santos JD, Skreta M, Erdman L, Weaver J, Fermin AS, Tasian G, Lorenzo AJ, Rickard M. Predictive accuracy of prenatal ultrasound findings for lower urinary tract obstruction: A systematic review and Bayesian meta-analysis. Prenat Diagn 2021; 41:1039-1048. [PMID: 34318486 DOI: 10.1002/pd.6025] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lower urinary tract obstruction (LUTO) is a rare but critical fetal diagnosis. Different ultrasound markers have been reported with varying sensitivity and specificity. AIMS The objective of this systematic review and meta-analysis was to identify the diagnostic accuracy of ultrasound markers for LUTO. MATERIALS AND METHODS We performed a systematic literature review of studies reporting on fetuses with hydronephrosis or a prenatally suspected and/or postnatally confirmed diagnosis of LUTO. Bayesian bivariate random effects meta-analytic models were fitted, and we calculated posterior means and 95% credible intervals for the pooled diagnostic odds ratio (DOR). RESULTS A total of 36,189 studies were identified; 636 studies were available for full text review and a total of 42 studies were included in the Bayesian meta-analysis. Among the ultrasound signs assessed, megacystis (DOR 49.15, [15.28, 177.44]), bilateral hydroureteronephrosis (DOR 41.33, [13.36,164.83]), bladder thickening (DOR 13.73, [1.23, 115.20]), bilateral hydronephrosis (DOR 8.36 [3.17, 21.91]), male sex (DOR 8.08 [3.05, 22.82]), oligo- or anhydramnios (DOR 7.75 [4.23, 14.46]), and urinoma (DOR 7.47 [1.14, 33.18]) were found to be predictive of LUTO (Table 1). The predictive sensitivities and specificities however are low and wide study heterogeneity existed. DISCUSSION Classically, LUTO is suspected in the presence of prenatally detected megacystis with a dilated posterior urethra (i.e., the keyhole sign), and bilateral hydroureteronephrosis. However, keyhole sign has been found to have modest diagnostic performance in predicting the presence of LUTO in the literature which we confirmed in our analysis. The surprisingly low specificity may be influenced by several factors, including the degree of obstruction, and the diligence of the sonographer at searching for and documenting it during the scan. As a result, providers should consider this when establishing the differential for a fetus with hydronephrosis as the presence or absence of keyhole sign does not reliably rule in or rule out LUTO. CONCLUSIONS Megacystis, bilateral hydroureteronephrosis and bladder wall thickening are the most accurate predictors of LUTO. Given the significant consequences of a missed LUTO diagnosis, clinicians providing counselling for prenatal hydronephrosis should maintain a low threshold for considering LUTO as part of the differential diagnosis.
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Affiliation(s)
- Daniel T Keefe
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jin Kyu Kim
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Michael Chua
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Tim Van Mieghem
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Priyank Yadav
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Marisol Lolas
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Joana Dos Santos
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Marta Skreta
- Centre for Computational Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Lauren Erdman
- Centre for Computational Medicine, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - John Weaver
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Antoine Selman Fermin
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gregory Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Armando J Lorenzo
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Mandy Rickard
- Division of Urology, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
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Fontanella F, Duin LK, Adama van Scheltema PN, Cohen‐Overbeek TE, Pajkrt E, Bekker M, Willekes C, Bax CJ, Gracchi V, Oepkes D, Bilardo CM. Prenatal diagnosis of LUTO: improving diagnostic accuracy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:739-743. [PMID: 29266464 PMCID: PMC6587765 DOI: 10.1002/uog.18990] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 11/13/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To propose a clinical score for the optimal antenatal diagnosis of fetal lower urinary tract obstruction (LUTO) in the second and third trimesters of pregnancy, as an alternative to the commonly used ultrasound triad of megacystis, keyhole sign and hydronephrosis. METHODS This was a national retrospective study carried out at the eight tertiary fetal medicine units (FMUs) in The Netherlands. Only cases referred for megacystis from the second trimester onwards and with a clear postnatal diagnosis were included in the study. At referral, data were collected on amniotic fluid volume, renal cortical appearance, bladder volume, hydronephrosis, fetal ascites, ureteral size, keyhole sign, fetal sex and gestational age. Multivariate analysis was performed, starting by including all antenatal variables, and then excluding the weakest predictors using the backward stepwise strategy. RESULTS Over a 7-year period, 312 fetuses with a diagnosis of megacystis were referred to the eight Dutch tertiary FMUs. A final diagnosis was achieved in 143 cases, including 124 of LUTO and 19 reclassified after birth as non-obstructive megacystis. The optimal bladder volume cut-off for prediction of LUTO was 35 cm3 (area under the curve (AUC) = 0.7, P = 0.03). The clinical score formulated on the basis of the multivariate analysis included fetal sex, degree of bladder distension, ureteral size, oligo- or anhydramnios and gestational age at referral. The combination of these five variables demonstrated good accuracy in discriminating LUTO from non-obstructive megacystis (AUC = 0.84, P < 0.001), compared with the poor performance of the ultrasound triad (AUC = 0.63, P = 0.07). CONCLUSIONS We propose a clinical score that combines five antenatal variables for the prospective diagnosis of congenital LUTO. This score showed good discriminative capacity in predicting LUTO, and better diagnostic accuracy compared with that of the classic ultrasound triad. Future studies to validate these results should be carried out in order to refine antenatal management of LUTO and prevent inappropriate fetal interventions. © 2017 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. Fontanella
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - L. K. Duin
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
| | - P. N. Adama van Scheltema
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - T. E. Cohen‐Overbeek
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal MedicineErasmus MC University Medical CenterRotterdamThe Netherlands
| | - E. Pajkrt
- Department of ObstetricsAcademic Medical Center AmsterdamAmsterdamThe Netherlands
| | - M. Bekker
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisRadboud University Medical CenterNijmegenThe Netherlands
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - C. Willekes
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical CenterGrow School for Oncology and Medical BiologyMaastrichtThe Netherlands
| | - C. J. Bax
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisVU University Medical CenterAmsterdamThe Netherlands
| | - V. Gracchi
- Department of PediatricsUniversity Medical Center Groningen, University of GroningenThe Netherlands
| | - D. Oepkes
- Department of Obstetrics, Gynaecology and Prenatal DiagnosisLeiden University Medical CenterLeidenThe Netherlands
| | - C. M. Bilardo
- Department of Obstetrics, Gynaecology and Prenatal Diagnosis, University Medical Center GroningenUniversity of GroningenThe Netherlands
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Chitrit Y, Bourdon M, Korb D, Grapin-Dagorno C, Joinau-Zoulovits F, Vuillard E, Paye-Jaouen A, Peycelon M, Belarbi N, Delezoide AL, Schmitz T, El Ghoneimi A, Sibony O, Oury JF. Posterior urethral valves and vesicoureteral reflux: can prenatal ultrasonography distinguish between these two conditions in male fetuses? Prenat Diagn 2016; 36:831-7. [DOI: 10.1002/pd.4868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 06/20/2016] [Accepted: 06/26/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Yvon Chitrit
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Mathilde Bourdon
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Diane Korb
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | | | | | - Edith Vuillard
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Annabel Paye-Jaouen
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Matthieu Peycelon
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Nadia Belarbi
- Department of Pediatric Imaging; Hôpital Robert Debré AP-HP; Paris France
| | - Anne-Lyse Delezoide
- Department of Developmental Biology; Hôpital Robert Debré AP-HP; Paris France
| | - Thomas Schmitz
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Alaa El Ghoneimi
- Department of Pediatric Urology and Surgery; Hôpital Robert Debré AP-HP; Paris France
| | - Olivier Sibony
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
| | - Jean-François Oury
- Department of Obstetrics and Gynecology; Hôpital Robert Debré AP-HP; Paris France
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Quibel S, Brasseur-Daudruy M, Liard-Zmuda A, Gaillard P, Verspyck E. Posterior urethral valves: how the study of fetal micturition can help to reach the diagnosis? Prenat Diagn 2016; 36:794-5. [PMID: 27351949 DOI: 10.1002/pd.4865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/17/2016] [Accepted: 06/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Solene Quibel
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | | | - Agnes Liard-Zmuda
- Department of Pediatric Surgery, Rouen University Hospital, Rouen, France
| | - Pascale Gaillard
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
| | - Eric Verspyck
- Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France
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Accurate Diagnosis of Severe Hypospadias Using 2D and 3D Ultrasounds. Case Rep Obstet Gynecol 2016; 2016:2450341. [PMID: 27774326 PMCID: PMC5059589 DOI: 10.1155/2016/2450341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/17/2022] Open
Abstract
The hypospadias is the most common urogenital anomaly of male neonates but the prenatal diagnosis of this is often missed before birth. We present the prenatal diagnosis of a severe penoscrotal hypospadias using 2D and 3D ultrasounds. 3D sonography allowed us the best evaluation of the genitals and their anatomical relations. This ample detailed study allowed us to show the findings to the parents and the pediatric surgeon and to configure the best information about the prognosis and surgical treatment.
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Wen JG, Lu YT, Cui LG, Bower WF, Rittig S, Djurhuus JC. Bladder function development and its urodynamic evaluation in neonates and infants less than 2 years old. Neurourol Urodyn 2014; 34:554-60. [PMID: 24788785 DOI: 10.1002/nau.22626] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 04/02/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Jian Guo Wen
- Pediatric Urodynamic Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou P.R. China
| | - Yu Tao Lu
- Pediatric Urodynamic Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou P.R. China
| | - Lin Gang Cui
- Pediatric Urodynamic Centre; First Affiliated Hospital of Zhengzhou University; Zhengzhou P.R. China
| | - Wendy Fiona Bower
- Department of Epidemiology and Preventive Medicine; School of Public Health, Monash University; Melbourne Australia
| | - Soren Rittig
- Department of Paediatrics; Aarhus University Hospital; Aarhus N Denmark
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Chitayat D, Glanc P. Diagnostic approach in prenatally detected genital abnormalities. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 35:637-646. [PMID: 20521311 DOI: 10.1002/uog.7679] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Odeh M, Ophir E, Bornstein J. Hypospadias mimicking female genitalia on early second trimester sonographic examination. JOURNAL OF CLINICAL ULTRASOUND : JCU 2008; 36:581-583. [PMID: 18431748 DOI: 10.1002/jcu.20481] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Female fetal sex was assigned based on downward direction of the genital tubercle at 14 weeks' gestation. Subsequently, amniocentesis performed due to the finding of an echogenic focus in the left ventricle revealed a male karyotype. Sonographic examination at 22 weeks' gestation revealed a markedly curved penile shaft. Power Doppler at that time demonstrated a urine jet emanating from the penile base, verifying the diagnosis of penoscrotal hypospadias. We therefore suggest that female fetal sex assignment should be based on the demonstration of the 2 or 4 parallel lines representing the labial folds and not only upon the demonstration of the downward direction of the genital tubercle.
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Affiliation(s)
- Marwan Odeh
- Department of Obstetrics and Gynecology, Western Galilee Hospital, Rappaport Faculty of Medicine, Technion, Nahariya 22100, Haifa, Israel
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Vijayaraghavan SB. Fetal perineal sonography in the diagnosis of ectopic ureteric opening. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:347-51. [PMID: 17323302 DOI: 10.1002/uog.3937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We describe the technique of fetal perineal sonography and its use in the diagnosis of ectopic ureteric opening. Using a high-frequency probe, sagittal ultrasound imaging of the fetal perineum, pelvis and external genitalia was performed and proved useful in the diagnosis of ectopic ureteric opening into the urethra in one female and two male fetuses.
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Current awareness in prenatal diagnosis. Prenat Diagn 2005; 25:93-8. [PMID: 15706703 DOI: 10.1002/pd.1015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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